Authorization to Use or Disclose Protected Health Information: Fill out & sign online

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

The fastest way to redact Authorization to Use or Disclose Protected Health Information online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Dochub is the best editor for modifying your documents online. Follow this straightforward guide to edit Authorization to Use or Disclose Protected Health Information in PDF format online for free:

Sign up and sign in. Create a free account, set a secure password, and go through email verification to start managing your templates.
Add a document. Click on New Document and choose the form importing option: upload Authorization to Use or Disclose Protected Health Information from your device, the cloud, or a protected link.
Make changes to the template. Use the upper and left-side panel tools to edit Authorization to Use or Disclose Protected Health Information. Insert and customize text, pictures, and fillable fields, whiteout unnecessary details, highlight the important ones, and provide comments on your updates.
Get your documentation done. Send the form to other people via email, create a link for faster document sharing, export the template to the cloud, or save it on your device in the current version or with Audit Trail added.

Try all the benefits of our editor today!

See more Authorization to Use or Disclose Protected Health Information versions

We've got more versions of the Authorization to Use or Disclose Protected Health Information form. Select the right Authorization to Use or Disclose Protected Health Information version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2013	4.8 Satisfied (216 Votes)
2011	4.6 Satisfied (31 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Contact us

Should I accept or decline HIPAA authorization?

This is a form used in the nonstandard auto market, for people who do not qualify for automobile insurance from the usual sources because of their bad driving record. Such drivers are required to sign a disclosure authorization form before coverage can be put in force.

What is disclosure authorization?

When Must Patient Authorization be Obtained for Uses and Disclosures of PHI? Authorizations are generally required for psychotherapy notes, substance abuse disorder and treatment records, and for marketing purposes.

What is an example of when authorization is needed for use and disclosure of PHI?

A covered entity is permitted, but not required, to use and disclose protected health information, without an individuals authorization, for the following purposes or situations: (1) To the Individual (unless required for access or accounting of disclosures); (2) Treatment, Payment, and Health Care Operations; (3)

What is an authorization to disclose protected health information?

A Privacy Rule Authorization is an individuals signed permission to allow a covered entity to use or disclose the individuals protected health information (PHI) that is described in the Authorization for the purpose(s) and to the recipient(s) stated in the Authorization.